Clinical Research |
Translational Research |
Innovative Technology |
Personalized Medicine |
The CTRI announces the selection of the 2014 Pilot Projects. Sixteen projects were chosen in five categories, including Clinical Research, Translational Research, Innovative Technology, Personalized Medicine, and Academic-Community Partnership. Pilot Project grants are one-year competitive cash awards for researchers to obtain preliminary data. In the first four categories they range from $25,000 to $50,000 and in the Academic-Community Partnership category they are for $15,000. Funding priority is given to junior faculty members. Below are the 2014 projects.
Funding Period is 4/1/2014 through 3/31/2015.
Clinical Research Pilot Projects
Carolyn Allard, PhD
UC San Diego Veterans Medical Research Foundation
Title: A Pilot Test of the Effectiveness of a Pre-PTSD-treatment Emotion Regulation and Distress Tolerance Skills Building Group on PTSD Treatment Engagement and Effectiveness in Survivors of Military Sexual Trauma
Military sexual trauma (MST) is a disturbingly common occurrence that puts survivors at high risk for developing post-traumatic stress disorder (PTSD). In 2012, 23.6% of female veterans and 1.2% of male veterans reported experiencing MST to a VA provider, and research suggests actual prevalence rates may be much higher. MST is associated with PTSD, mood and other anxiety disorders, functional impairment, reduced quality of life, and poor physical health.
The objective of this clinical research is to test the utility of a novel PTSD treatment preparation group intervention, PTSD-Prep, in improving treatment outcomes for veterans who are diagnosed with PTSD related to MST in a randomized pilot trial with 24 veterans. The goal of the 12-session DBT-based PTSD-Prep group is to equip Veterans with emotion regulation and distress tolerance skills prior to engagement in group-based empirically supported treatment for PTSD (Cognitive Processing Therapy [CPT]). Participants will be recruited from the VA San Diego MST Clinic. In Phase I, following initial assessment, veterans will be randomized to 12 weekly PTSD-Prep group sessions or 12 weekly non-therapeutic peer support group sessions. In Phase II, which will begin within one month of the end of Phase I, all 24 veterans will engage in 12 sessions of group CPT. Dependent measures will include structured diagnostic interviews and self-report measures of symptom severity, emotion regulation and distress tolerance difficulties, and treatment satisfaction.
We hypothesize that the veterans who receive PTSD-Prep will have lower attrition rates and show greater reductions in PTSD symptom severity at the end of Phase II. Further, we expect that the PTSD-Prep group will display fewer difficulties with emotion regulation and distress tolerance. If our hypotheses are supported, the results will be used to support an extramural grant application to fund a larger clinical trial that will have potential for immediate clinical impact in a high-need population.
Luis Castellanos, MD
UC San Diego Department of Medicine, Division of Cardiology
Title: Pilot Study to Evaluate the Feasibility and Effectiveness of a Home-based Cardiac Rehabilitation Program in Patients with Coronary Heart Disease
Cardiac rehabilitation (CR), a multifaceted program consisting of cardiac risk factor modification, prescriptive exercise therapy and medication adherence, has been shown to be effective in secondary prevention of cardiovascular diseases. In particular, participation in CR has been associated with significant reductions in overall mortality, recurrent myocardial infarcts, rehospitalizations, and depressive symptoms in patients with coronary heart disease (CHD).
Despite these benefits, approximately half of eligible patients do not receive CR. Referral and participation rates are lower among patients from rural areas, as well as individuals from vulnerable populations. In particular, women, and racial and ethnic minority patients with heart disease tend to have lower CR use rates when compared to the general population. Economic and environmental factors have also been shown to reduce participation rates in CR programs. Therefore, alternative modes of delivery of CR services have been advocated by cardiovascular societies. In the United Kingdom, home-based CR programs that use a self-help manual have shown benefits similar to hospital-based CR; yet, home-based CR programs have not been well evaluated in the United States.
The aim of the study project is to evaluate the feasibility and effectiveness of a home-based CR program manual in patients with CHD who do not have access to CR. Effectiveness of the home-based CR program would be measured by evaluating reduction in traditional cardiac risk factors and improvement in health-related quality of life (HRQOL) at the end of the treatment period.
Inna Fishman, PhD
San Diego State University
Title: Neural Generators of Emotional Mimicry (and Lack Thereof) in Autism
Humans, infants and adults alike, automatically mimic a variety of behaviors in everyday social situations. One of the most robust examples of mimicry is the spontaneous mirroring of others' emotional facial expressions. This automatic imitation facilitates social functioning, interpersonal rapport, and emotion-recognition and understanding. Critically, this fundamental social behavior is impaired in autism, a neurodevelopmental disorder characterized by deficits in social functioning and affecting as many as one in 88 children. Yet, while autism has become an urgent public health issue due to its increasing prevalence, the neural mechanisms underlying these behavioral impairments remain largely unknown.
We propose a highly novel and immediately applicable research plan to investigate the basic brain networks that drive mimicry, or lack thereof, in individuals with autism spectrum disorders (ASD), using a multimodal approach linking facial muscle output (measured with facial EMG) to real-time neural signal (measured with functional MRI). By simultaneously combining these two modalities during observation and imitation of facial expressions, we will be able to localize emotional mimicry to specific neural networks (utilizing functional connectivity, or fcMRI, analyses). Results of this investigation into the neural (both central and peripheral) and behavioral underpinnings of facial mimicry in ASD, and, by extension, emotion understanding, empathy, and social functioning, can offer insight into possible core phenotype and advance our understanding of this prevalent neurodevelopmental disorder. Further, advancing our knowledge at the level of both central (brain) and peripheral (muscles) generators of imitation in ASD is especially promising in light of our recent findings (Winkielman, et al.) demonstrating that facial feedback training using automated facial expression software can improve emotion recognition.
Jane Kim, MD
UC San Diego Department of Pediatrics
Title: Profiling Metabolomic Signatures in Children with Type 2 Diabetes
There are 312 million individuals with Type 2 Diabetes (T2D) worldwide. T2D is increasing more rapidly in children than in any other age group, and appears to have a more aggressive course in youth with serious complications such as hypertension, retinopathy and nephropathy appearing just a few years after diagnosis.
Research indicates that the substantially increased risk of early death associated with T2D is primarily confined to those with chronic kidney disease (CKD). Currently, the presence of urine albumin is used to predict CKD and eventual end-stage kidney disease. However, albuminuria only identifies 30% of those who progress to overt nephropathy. If diabetic individuals with early kidney disease can be identified, they may be treated with medications to prevent CKD. It is important to develop reliable biomarkers for early kidney disease.
We propose to employ a mass spectrometry (MS)-based metabolomics platform to generate distinct metabolite signatures that 1) predict the development of T2D in obese children, and 2) predict the development of CKD in diabetic children, identifying those at higher risk for complications and premature death. Urine and plasma samples will be collected from three groups of children aged 12-18: 1) obese male and female subjects with early T2D (<2 years from diagnosis); 2) obese, age- and gender-matched subjects without diabetes; and 3) age- and gender-matched normal weight controls. 105 metabolites in each sample will be measured by GS-MS.
Dawn Meyer, PhD
UC San Diego Department of Neurosciences
Title: Is Platelet Hyperactivity the Key to Increased Stroke Recurrence in Post-Stroke Depression
Platelet activity and aggregation play a key role in vascular risk. Healthy patients with the diagnosis of depression have significantly hyperactive and hyperaggregable platelets. Post-stroke depression occurs in 30-46% of acute stroke patients. Despite current optimal antiplatelet therapy, patients with post-stroke depression have a three-fold increased risk of recurrent stroke. The hypothesis being tested is that platelet hyperactivity and hyperaggregability is the key to increased stroke recurrence in patients with post-stroke depression. The purpose of this study is to assess for significant differences in depressed versus non-depressed acute stroke patients for: 1) platelet aggregation and activation, 2) pro-atherosclerotic platelet derived markers, and 3) radiologic markers of atherosclerosis as a potential etiology of increased stroke recurrence.
Hypothesis 1: Platelet activation and aggregation will be significantly elevated in depressed stroke patients (as measured by CD62P, CD41, collagen, arachidonic acid, adenosine diphosphate). Hypothesis 2: Platelet derived inflammatory markers that contribute to atherosclerosis will be significantly elevated in depressed stroke patients (as measured by CD40, Soluble CD40, Beta-thromboglobulin [β-TG], Platelet factor 4). Hypothesis 3: Depressed stroke patients will have significant carotid atherosclerosis as measured by percentages of stenosis on carotid artery ultrasound.
Charles Taylor, PhD
UC San Diego Department of Psychiatry
Title: Positive Valence System Enhancement Treatment for Anxiety and Depression: Clinical Efficacy and Neural Changes
Anxiety and depression are highly prevalent and disabling conditions that frequently co-occur, and are costly to the individual and society. Despite important advances in understanding the pathophysiology of these disorders, many individuals fail to achieve full recovery following our most successful treatment approaches. Recent efforts to integrate advances in neuroscience with clinical psychiatry suggests a heuristic framework in which anxiety and depression can be conceptualized along partially distinct biobehavioral dimensions of positive and negative valence system domains. Existing treatments primarily target the negative valence system, emphasizing the reduction of negative affect and distress as the central treatment goal. Considerably less attention has been devoted to identifying interventions that modulate functioning of the positive valence system. The positive valence system guides people toward situations with reward potential, thereby facilitating the acquisition of psychosocial resources that promote overall health and well-being. In contrast, anxiety and depression are associated with marked disturbances of the positive valence system, for example, diminished responsiveness to reward stimuli and less frequent and intense pleasurable experiences. Thus, a critical unmet need exists to identify novel treatment approaches designed to target dysfunctions in biobehavioral mechanisms of the positive valence system.
Aim 1 will test the hypothesis that participants randomized to the positive valence system enhancement intervention will display greater increases in positive affect, greater reactivity to reward-relevant stimuli, and enhanced activity in neural systems that regulate responses to reward (e.g., nucleus accumbens) relative to participants in the waitlist control group.
Aim 2 will explore whether the effects of the positive valence system treatment generalize to parallel measures of the negative valence system (i.e., negative affect, reactivity to aversive stimuli, and fear extinction). This project has the potential to pioneer major advances in the field by being the first, to our knowledge, to test the efficacy of a comprehensive treatment regimen designed to explicitly target core domains of the positive valence system in a clinical sample of anxious or depressed individuals.
Translational Research Pilot Projects
Taylor Doherty, MD
UC San Diego Department of Rheumatology, Allergy & Immunology
Title: Regulation of Type 2 Innate Lymphoid Cells in Asthma
Human asthma is largely characterized by a type 2 lung inflammatory response that leads to airway eosinophilia, mucus production, hyperreactivity and remodeling. Th2 cytokines, including IL-4, IL-5 and IL-13, promote many of these features of asthma and the cellular source of these cytokines has been attributed to conventional CD4+ T cells. However, the recent discovery of a novel population of lineage-negative Th2 cytokine producing cells, termed type 2 innate lymphoid cells or "ILC2" has challenged this paradigm. Importantly, ILC2 have been shown to contribute to type 2 lung inflammation and airway hyperreactivity in mice, suggesting a potential role in human asthma. Although ILC2 have recently been detected in human tissues, mechanisms that regulate human lung ILC2 are unknown. Importantly, understanding factors that control ILC2 function may lead to future therapies targeting ILC2 in asthma and allergy.
Specific Aim 1. To determine the levels of RBM3 expression and Th2 cytokines in stimulated human lung and peripheral blood ILC2. We will culture sorted lung ILC2 from human cadaveric lungs and peripheral blood with TSLP and other known activators of ILC2 including IL-33 and prostaglandin D2. We will measure levels of IL-4, IL-5, and IL-13 by ELISA and determine expression levels of RBM3 by FACS and qPCR in stimulated compared with unstimulated ILC2.
Specific Aim 2. To determine the role of RBM3 in human lung ILC2 cytokine production and proliferation. We will culture purified lung and peripheral blood RBM3 knockdown ILC2 and control siRNA-treated ILC2 with TSLP, IL-33 and prostaglandin D2. We will measure levels of IL-4, IL-5, and IL-13 by ELISA, as well as Ki-67+ proliferating ILC2 by FACS. Further, we will assess levels of the Th2 cytokine master transcription factor GATA-3 by flow cytometry. RBM3 knockdown ILC2 Th2 cytokine production, proliferation and GATA-3 expression will be compared with control siRNA-treated ILC2.
Sara Gianella Weibel, MD
UC San Diego Center for AIDS Research
Title: Mechanisms of HIV Persistence
The exact mechanism of viral persistence during antiretroviral therapy (ART) is still controversial. Having a "suppressed viral load" does not imply that viral replication has stopped and there is evidence that replication may continue at low levels. However, other studies demonstrated that proviral HIV DNA is preferentially detected in proliferating CD4+ T-cells, and that increasing proportion of monotypic HIV DNA sequences are progressively found during suppressive ART, suggesting that homeostatic cellular proliferation is a crucial mechanism of HIV persistence. Understanding the exact mechanism of HIV persistence and determining which factors (e.g., chronic immune activation, co-infections) are most likely influencing the maintenance of the latent reservoir during long-term suppressive ART is crucial in order to design effective strategies to cure HIV.
Using next generation sequencing (NGS) techniques and an innovative method to link each provirus to its unique integration site within the human genome, we will determine how the latent HIV reservoir is sustained during suppressive ART in relation to CD4+ T-cells immune activation. Our hypothesis is that during long-term suppressive ART (>8 years), increased levels of CD4+ T-cells immune activation will be associated with homeostatic proliferation of HIV-infected CD4+ T cells, as determined by an increase of monotypic HIV DNA sequences with identical integration site.
Jona Hattangadi-Gluth, MD
UC San Diego Department of Radiation Medicine & Applied Sciences
Title: Quantitative Neuroimaging and Neurocognitive Assessment to Measure Radiation-Induced Brain Injury in Non-targeted Tissue: Implications for Cognitive Preservation
Fractionated radiation therapy is a mainstay in the treatment of primary and metastatic brain tumors, however results in an inevitable decline in neurocognitive functioning. These radiation effects are mediated by tissue injury to white matter and neuronal injury to the hippocampus. With quantitative magnetic resonance imaging (MRI) techniques, we can directly and non-invasively measure such changes. The purpose of this study is to examine radiation-induced imaging changes in normal, non-tumor brain tissue and correlate with neurocognitive outcome after treatment. The overarching goal is to better understand these "bystander effects," identifying particularly sensitive brain regions so that future radiation techniques can be optimally designed to mitigate collateral damage.
Specific Aims: 1) To identify microstructural changes in white matter integrity associated with quantified regional exposure to brain radiotherapy using advanced diffusion weighted imaging and matched overlays of radiation dose maps; 2) To measure microstructural and volume changes to the hippocampus associated with quantified regional exposure to brain radiotherapy using volumetric MRI and advanced diffusion weighted imaging in conjunction with matched overlays of radiation dosage maps; and 3) To correlate imaging findings from Specific Aims 1 and 2 with domain-specific neurocognitive changes.
Ji Zhang, MD, PhD
UC San Diego Department of Pharmacology
Title: Genetic Association Study of the Mitochondrial Phosphatase PTPMT1 in Metabolic Syndrome
Metabolic Syndrome (MetS) is a constellation of disorders, including obesity, dyslipidemia, hypertension, and insulin resistance. Due to a rise in obesity rates nationwide, MetS has become more prevalent and poses a huge burden to the public health system. The incidence of coronary artery disease and myocardial infarction dramatically increases in MetS patients, but the underlying mechanism is presently unknown.
We plan to examine the genetic association of the PTPMT1 gene with body mass index (BMI), waist-to-hip ratio (WHR), serum lipid panel, homeostasis model assessment-estimated insulin resistance (HOMA-IR), as well as the presence/absence of concurring cardiovascular diseases.
The UC San Diego Transdisciplinary Research on Energetics and Cancer (TREC) Center has developed a large clinical trial to study insulin resistance, inflammation, and energetics in breast cancer survivors. We plan to collaborate with Dr. Cheryl Anderson, a cardiovascular epidemiologist at UC San Diego, and the TREC center to carry out dense genotyping analysis across the PTPMT1 locus in MetS patients identified by the TREC study. Genomic DNA from 50 normal subjects and 50 patients with MetS will be extracted, PCR amplified, and sequenced across its four exons, the intron/exon borders, untranslated regions, and proximal promoter. Statistical analysis will be subsequently performed for the association of PTPMT1 SNPs, including but not limited to rs11537752, with the clinical data obtained through the TREC study. We will determine whether any PTPMT1 SNP is enriched in patients with increased BMI, increased WHR, hyperlipidemia, high HOMA-IR, or cardiovascular complications.
Innovative Technology Pilot Projects
Drew Hall, PhD
UC San Diego Department of Electrical and Computer Engineering
Title: Smartphone-based Point-of-care Detection and Treatment Monitoring of Lipoarabinomannan (LAM) in Urine from HIV-associated Tuberculosis (TB) Patients in Remote Settings
Tuberculosis (TB) remains a major challenge to global health despite a formalized diagnosis and treatment algorithm devised by the World Health Organization (WHO). In 2010, there were an estimated 8.8 million incidents worldwide and of the 1.45 million deaths, nearly one-quarter were HIV-positive. TB is the leading cause of death in HIV-infected patients often going undiagnosed, even in hospitalized patients. Co-infection of HIV and TB is difficult to diagnose, particularly in resource-limited settings and in the field where symptom-based findings are inadequate. Furthermore, the conventional diagnostic practice is not portable and either too time consuming (sputum culture, up to 8 weeks) or not straight forward (X-ray imaging). Nucleic acid-based molecular diagnostic tests for TB deliver accurate results in a short time, but are confined to centralized laboratories due to the high installation cost (e.g., Xpert MTB/RIF assays). An ELISA-based strip-test for the qualitative detection of lipoarabinomannan (LAM) in urine (Determine®-TB) has been gaining relevance as a point-of-care (POC) diagnostic tool in HIV co-infected TB patients. LAM has been shown to be present in urine at concentrations of 10 ng/mL in smear-positive patients and 1 ng/mL in smear negative. Presently, the POC tests are only qualitative and not very sensitive. Thus, there remains a pressing need for an easy-to-use, yet sensitive, diagnostic tool to rule-in TB infection and initiate treatment where microbiological diagnosis is unavailable or would significantly delay treatment.
We propose to transform the smartphone into a powerful, low-cost medical diagnostic platform for rule-in detection of TB in resource-limited settings. The proposed system has three components: 1) a smartphone, 2) an electronic readout module, and 3) a one-time use disposable diagnostic chip. The electronic readout module contains an ultra-low power potientiostat and connects to the smartphone via the headphone jack to enable bi-directional communication and utilize power from the phone. This choice of interface presents technological challenges compared to other interfaces such as USB or Bluetooth; however, it is universally compatible with all smartphones and enables the module to be battery free. The disposable diagnostic chip contains all of the reagents necessary for the LAM assay (antibodies, surface chemistry, and electrochemical tag). The concentration of the LAM biomarker is quantified using a sensitive electrochemical detection technique based on cyclic voltammetry with redox cycling, with sensitivity which has been demonstrated down to 100 pg/mL. The entire procedure will be automated through an application running on the smartphone such that an untrained user can reliably run the assay. While existing POC offerings are only qualitative, our proposed platform is highly sensitive and quantitative. Furthermore, the entire system can be made extremely inexpensive allowing it to be used for therapy monitoring in addition to diagnostics.
Personalized Medicine Pilot Projects
Wenxian Fu, PhD
UC San Diego Department of Pediatrics
Title: Identifying The Initiating Factors in Type 1 Diabetes by Disclosing The Crosstalk Among Islet Vascular Inflammation, Immune Responses and β Cell Death
Type 1 diabetes (T1D) is a prototypic example of organ-specific autoimmune disease. Pathologically, the disease unfolds in a manner of chronic inflammation, with active involvements of vascular inflammation, immune cell trafficking and activation and β cell death and neogenesis. Though tremendous progress has been made, it remains largely unknown about what exactly triggers the disease and what regulates the initiation of the autoimmune inflammation (insulitis) and the transition from autoimmune phase to metabolic phase (onset of diabetes). Recently, increasing body of evidence supports the notion that the occurrence of biomarkers (e.g., autoantibodies), or signs of tissue pathology (islet microvascular inflammation) at very early stage is tightly correlated with the eventual development of diabetes later on. Thus, identifying early cellular and molecular mechanisms that regulate the key check-points of T1D progression will essentially be critical for the development of preventive strategies by targeting immune processes. Based on this scenario, we propose to tackle the issue of what the initiating factor in T1D is, and whether it originates from the changes in immune system, vasculature, or the β cell per se. Meanwhile, recently identified pancreatic perivascular macrophages would be a model system to study the links among the aforementioned variables.
*This project is co-funded by the UC San Diego/UCLA Diabetes Research Center. CTRI is providing $25,000.
Louise Laurent, MD, PhD
UC San Diego Department of Reproductive Medicine
Title: Whole Exome Sequencing for Prenatal Diagnosis
Prenatal diagnosis has already begun to move beyond karyotyping, which is limited to detection of large genetic aberrations, and detects a mutation in only about one-third of structurally abnormal fetuses. Recently, it was demonstrated that chromosomal microarray analysis, which is an intermediate-resolution genomic approach, results in identification of a causative mutation in an additional 6% of cases. It is only a question of time before yet higher resolution methods, such as exome sequencing (ES) or whole-genome sequencing (WGS) will be widely used for prenatal diagnosis. However, given the complexity of these technologies and fact that the results may be used to make sensitive, life altering decisions, it is critical that the process of their adoption into protocols for prenatal diagnosis be carried out in a thoughtful and responsible manner. In this pilot project, we will use ES for prenatal diagnosis in cases where a major fetal anatomic abnormality has been found on ultrasound but the fetal karyotype is normal.
To assess the psychological impact of use of ES for prenatal diagnosis, we will collaborate with Dr. Cinnamon Bloss at The Scripps Translational Science Institute, a clinical psychologist who has studied the impact of clinical genomics in non-pregnant populations. We will perform assessments of the mother, father, and clinician after enrollment and after transmission of results, using both structured questionnaires and semi-structured interviews. We will determine whether depression and anxiety symptoms change during the course of the study, and whether parents feel regret or distress related to the sequencing itself.
While there is potential for direct benefit to participants from discovery of causative mutations for specific fetal malformations in this study, the primary goals of this pilot project are to develop the infrastructure and know-how for future work, including development of an end-to-end pipeline for integrating ES into prenatal diagnosis, acquisition of preliminary results for project design, and identification of key questions for future research and extramural grant applications.
Lawrence Prince, MD, PhD
UC San Diego Department of Pediatrics
Title: Personalized Genomic Medicine in Preterm Infants
Bronchopulmonary Dysplasia (BPD) is a serious, chronic lung disease that exclusively affects extremely preterm infants. With 8,000 and 10,000 new cases each year, NIH and NORD classify BPD as a rare pediatric disease. With high rates of hospitalization and severe co-morbidities including pulmonary hypertension, patients with BPD place a huge burden on our medical system. No effective therapies exist for treating BPD, making it an important focus area for biomedical research and medical advancement. As part of a strategic initiative by the NHLBI, we are currently investigating the role of lung macrophages in BPD pathogenesis. Clinical and experimental data now link early exposure to inflammation with increased BPD risk. Based on both clinical findings and experimental data, we hypothesize that lung macrophage activation establishes a pro-inflammatory environment in the developing lung of a subset of extremely preterm infants. Soluble inflammatory mediators then inhibit normal developmental programs, leading to BPD. However, several important questions remain. 1. Does lung macrophage activation at birth lead to eventual development of BPD? 2. Do macrophages from patients at highest risk of BPD have an abnormal innate immune response? An ongoing study in our group is addressing these questions by obtaining lung macrophages from extremely preterm newborn infants born before 30-week gestation. Macrophages are then divided into two samples: one control and one treated with E. coli lipopolysaccharide (LPS). The funded project planned to measure cytokine expression in these patient samples using real time PCR. From these data, we hope to identify which patients might benefit from specific anti-inflammatory treatment or the potential use of new biological agents that target specific cytokines and inflammatory pathways.
The recent development of more sophisticated RNA Sequencing technology now gives us additional opportunities. We currently have obtained samples from 72 patients and have begun isolating high quality RNA from these 144 samples (two from each patient). Based on our preliminary data, we anticipate successful RNA isolation, purification, amplification and library production in at least 100 samples using the expertise and facilities of the UC San Diego Genomics Center. From these samples, we propose studying 40 samples from patients exposed to prenatal inflammation due to maternal chorioamnionitis, 40 control samples from patient delivered solely for maternal indications, and 20 samples from patient delivered preterm without clear etiology. Importantly, using control and LPS-treated samples from each patient will provide quality control and normalization for each patient.
Academic-Community Pilot Projects
Kate Murray, PhD
UC San Diego Department of Family & Preventive Medicine
Title: Improving Taxi Driver Health and Access to Health Care – A Community-Academic Partnership
The UC San Diego Department of Family and Preventive Medicine and the United Taxi Workers of San Diego (UTWSD) are partnering to support the reduction of health and health care disparities among San Diego taxi drivers. The goals of the partnership include the following: increasing awareness of health profiles of taxi drivers in San Diego; developing a collaborative relationship between UC San Diego SOM and UTWSD to bridge health education programs to underserved taxi drivers in San Diego; and increasing health care coverage of taxi drivers through targeted education and outreach efforts related to the Affordable Care Act. This community pilot project focuses on two specific aims of the partnership. Specific Aim 1. The UC San Diego School of Medicine (SOM) and UTWSD will conduct a health fair for San Diego taxi drivers. Few drivers are currently insured and the health fair aims to provide baseline objective health data for taxi drivers while disseminating information on the Affordable Care Act and serving as a bridge to more sustainable health care options. The health fair will focus on the assessment of musculoskeletal disorders, hypertension, and obesity. Additionally, the health fair setting will be used to recruit participants for the cross-sectional study in Aim 2.
Specific Aim 2. To collect objective health data from taxi drivers and increase knowledge of prominent musculoskeletal and other health concerns in the target population. Approximately 100 taxi drivers and an age-gender-matched comparison group will be recruited to complete individual assessments on musculoskeletal pain prevalence and severity, smoking history, fatigue, sleep quality and duration, symptoms of depression and anxiety, gastrointestinal disturbances, and details on the work environment such as job stress, hours worked, sedentary behavior, and other health behaviors during their typical work shift assessed via 24-hour recall. Initial participants will be recruited in the health fair setting and a respondent-driven sampling approach will be implemented to recruit additional taxi drivers and an age-gender-matched non-taxi driver cohort.
Jamila Stockman, PhD
UC San Diego Division of Global Public Health
Title: The Role of Peer Navigators and Social Support in the HIV Care Continuum: Perceptions of HIV-Positive Women
Increasing access to care and improving health outcomes for people living with HIV are cornerstones of the President's National HIV/AIDS Strategy. Extant data suggests that timely initiation of and sustained adherence to antiretroviral therapy (ART) can reduce HIV transmission by more than 90%. Achieving viral suppression in HIV-infected individuals confers benefits to the treated individual, sexual partners, and to the community. However, only one in four HIV positive people in the U.S. make it through the entire HIV care continuum (diagnosis, linkage to care, retention in care, ART initiation and adherence) to achieve this goal. In San Diego, an estimated 57% of HIV-positive women are not accessing care. This public health crisis warrants urgent attention, given that HIV/AIDS continues to disproportionately affect women of color in San Diego where most HIV-related resources are currently devoted to men who have sex with men. The San Diego HIV Prevention Community Planning Group has emphasized the need to bridge this gap for HIV-positive women via outreach and services. Peer Navigation services have helped HIV-positive patients better negotiate their care. However, evidence suggests drawing support from one's social network may further strengthen patients' care negotiation.
Accordingly, the goals and specific aims of this study are: 1) Utilize a mixed-methods study design to elicit barriers HIV-positive women face across the HIV care continuum and how Peer Navigator (PNs) services and social support networks (SSNs), those with whom close or emotional ties are shared, can be enhanced to improve outcomes; 2) Develop an intervention manual for use in a future study to test a culturally tailored program that utilizes SSNs to enhance PNs' role in improving engagement in care among HIV-positive women; and 3) Establish an ongoing collaborative research relationship between UC San Diego and Christie's Place* to strengthen available services for HIV-positive women in San Diego.
*Christie's Place is a nonprofit social service organization in San Diego County that provides comprehensive HIV/AIDS education, support, and advocacy to women, children and families impacted by HIV/AIDS.